Engaging communities to prevent underage drinking.

Community-based efforts offer broad potential for achieving population-level reductions in alcohol misuse among youth and young adults. A common feature of successful community strategies is reliance on local coalitions to select and fully implement preventive interventions that have been shown to be effective in changing factors that influence risk of youth engaging in alcohol use, including both proximal influences and structural and/or environmental factors related to alcohol use. Inclusion of a universal, school-based prevention curriculum in the larger community-based effort is associated with the reduction of alcohol use by youth younger than 18 years of age and can help reach large numbers of youth with effective alcohol misuse prevention.

R esearch has identified multiple risk factors that increase the likelihood of alcohol use among youth and young adults. These conditions or experiences include individual characteristics (e.g., displaying aggression at a young age or believing that alcohol use is not harmful), peer influences (e.g., having friends who use alcohol or who believe that alcohol use is acceptable), family experiences (e.g., heavy alcohol use by parents or siblings, or inadequate parental supervision), school factors (e.g., academic failure, or having a low commitment to school or education), and neighborhood experiences (e.g., availability of alcohol to youth, or community norms that are permissive of youth alcohol use) (Durlak 1998;Pentz 1998). Protective or promotive factors that ameliorate the negative influences of risk factors or directly reduce the likelihood of alcohol use among young people also exist in all areas of people's lives. They include, for example, being attached to others who do not abuse alcohol, having a resilient tempera ment, or holding clear standards against the use of alcohol before one is of legal age (Pollard et al. 1999;Werner 1993).
Prevention efforts aimed at reducing rates of alcohol use typically do so by seeking to minimize the target popula tion's exposure to harmful risk factors and/or enhance protective/promotive factors (Coie et al. 1993;Munoz et al. 1996). Focusing prevention efforts on youth offers partic ularly great potential, because the early onset of drinking has been associated with an increased likelihood of alcohol dependence later in life (Hingson et al. 2006). Although many prevention efforts have been found to reduce tobacco, alcohol, and other drug use (Hawkins et al. 1995;National Research Council and Institute of Medicine 2009;Spoth et al. 2008), these strategies often are limited by addressing risk and protective factors in just one socialization domain. Thus, most of these efforts focus only on the most direct (i.e., proximal) causes of alcohol use, such as the availability of alcohol or peer or family influences, rather than targeting the complex contexts in which youth and young adults live. This narrow focus may reduce the overall impact and longterm effectiveness of alcoholabuse prevention strategies, both because multiple factors affect alcohol use and because the effectiveness of any intervention likely is compromised if the environment in which people live is unfavorable to or does not support intervention goals and activities (Flay 2000;Wagenaar and Perry 1994).
One at least equally promising strategy for affecting rates of alcohol use, abuse, and dependence (not just among youth and young adults) centers on community based efforts. Such approaches rely on multiple strategies intended to change a variety of factors that place individ uals at risk for engaging in alcohol misuse (Pentz 1998;Wandersman and Florin 2003). Most of these efforts seek to alter not only proximal influences, but also the long term, structural, and environmental influences associated with alcohol abuse and dependence, which increases their potential to make a significant and longlasting impact (Wagenaar et al. 1994). By saturating the environment with prevention strategies and messages, communitybased efforts aim to reach many individuals, which may allow them to achieve populationlevel reductions in alcohol misuse.
Another potential advantage of communitybased strategies is their reliance on members of the local community to plan, implement, and monitor prevention activities, usually via coalitions made up of stakeholders from diverse orga nizations and backgrounds. By actively involving the com munity in the prevention effort, these approaches may enhance community buyin for prevention activities and may help to ensure that services are a good fit with local needs, resources, and norms (Hawkins et al. 2002;Stevenson and Mitchell, 2003;Wandersman et al. 2003;Woolf 2008). The levels of risk and protective/promotive factors vary across communities, and measures most needed in one community to reduce youth alcohol use may not be needed in another community (Hawkins et al. 2002;Reiss and Price 1996). Thus, prevention efforts that are based upon assessing local needs (i.e., risk and protective/ TARGETED PREVENTION APPROACHES-WHAT WORKS promotive factors faced by those in the community) and implementing prevention strategies that are best suited to address these needs may be more effective than implementing a single prevention program across many communities. Community mobilization also may allow for effective pooling of information and resources across agencies and individuals, minimizing duplication of services, and potentially offering more costeffective services that can be imple mented better and are more likely to be sustained.
After defining what exactly community mobilization implies, this article explores what communitybased strategies work to reduce alcohol use and misuse among youth and the role of schoolbased interventions in the context of com munitylevel efforts. Finally, the article looks at the chal lenges associated with the successful implementation of communitybased programs to prevent youth alcohol use.

What Is Community Mobilization to Prevent Alcohol Misuse?
Existing communitybased alcohol abuse prevention efforts are tailored to local circumstances, which makes it diffi cult to identify the specific components that define this type of approach. Nonetheless, community mobilization efforts have in common the goal of reducing alcohol misuse by changing the larger environment, using approaches that are owned and operated by the local community (Wandersman et al. 2003). Most programs rely on coali tions of community stakeholders to collaboratively plan and coordinate prevention activities. In some cases, coali tions focus on implementing, in a coordinated fashion, multiple, discrete prevention programs and practices that seek to decrease elevated risk factors and enhance depressed protective/promotive factors related to alcohol use (Hawkins et al. 2002). Other efforts specifically focus on transforming the environment via changes in local ordinances, norms, and policies related to alcohol. These latter efforts target a more limited number of risk factors, particularly com munity norms and laws related to alcohol use, the avail ability of alcohol, and individual attitudes favorable to alcohol use (Pentz 2000). Some communitybased efforts rely on a combination of these strategies.

What CommunityBased Strategies Work to Reduce Alcohol Misuse Among Youth?
The findings presented in this article are based upon a com prehensive review of evaluations conducted in the United States that involved the implementation of a substantial, communitybased prevention initiative aimed at reducing alcohol and other drug (AOD) use among minors (i.e., ado lescents and young adults age 20 or younger). Projects were included in the review if they met the following criteria: • They were evaluated using a wellconducted quasi experimental or true experimental design that involved, at a minimum, one intervention group (implementing the strategy) and one comparison group.
• Data on alcohol use outcomes were collected at least twice during the research project (e.g., before and after the intervention was conducted).
• There were no significant threats to the validity and relia bility of the study, as determined by the first two authors of this review.
Although many studies were reviewed, only nine communitybased initiatives demonstrated reduced rates of alcohol use or alcohol availability among youth and young adults according to the above criteria (see the table). It is notable that several of these strategies affected not only alcohol use but also the use of tobacco and, in some cases, other illicit drugs. The table briefly describes each program, the population in which the intervention was evaluated, and the program's significant effects in reducing AOD use.
The findings allow the following conclusions. First, a common feature of successful communitybased prevention approaches is reliance on local coalitions to select effective preventive interventions and implement them with fidelity. Second, the inclusion of a universal, schoolbased drug prevention curriculum as part of the larger community initiative is associated with reductions in alcohol use among middle and highschool students. Third, environmental strategies focused on changing local laws, norms, and policies related to alcohol access and use do not appear to reduce alcohol use among adolescents younger than age 18 when implemented independently of other community based strategies. However, they have been part of successful multicomponent interventions and, when implemented on their own, have reduced the availability of alcohol in communities and lowered the rate of drunkdriving arrests among young adults.

Reliance on Community Coalitions
All of the communitybased initiatives listed in the table relied on local coalitions to plan and implement prevention activities. This observation indicates that to be successful, community efforts must ensure the presence of active, broadbased groups of individuals who believe it is possible to prevent youth AOD use and who are willing to engage in collaborative prevention activities. Although coalitions vary in their structures, sizes, goals, and activities, a defining feature of such groups is their focus on facilitating desired changes through collaborative action. Although the specific members of a coalition may vary depending on the focus of the group, coalitions usually seek to be broad based and to unite diverse stakeholders and key leaders from key agencies and sectors of the community. For example,  (Collins et al. 2007) targeting risk and protective factors 25,032 students in and binge drinking among related to drug use with effective grades 8 and 10 10th graders programs conducted in schools and other community agencies Communities That Care (CTC) Coalitionbased prevention strategy 24 communities in 7 States; Reduced the initiation of smoke  targeting elevated risk and 4,407 students in grade 5 less tobacco, smoking, and alcohol depressed protective factors related to drug use with effective programs Reduced pastmonth use of smokeless tobacco, alcohol, conducted in schools and other community agencies for peer review and binge drinking

Midwestern Prevention Project
Combines coalitionled community 42 schools in Kansas City; Reduced pastmonth smoking (Pentz et al. 1989) mobilization strategies with the 5,065 students in grades 6 and drinking implementation of schoolbased and 7 prevention curricula

Project SixTeen
Combines coalitionled community 16 communities in Oregon; Reduced smoking, drinking, and (Biglan et al. 2000) mobilization strategies with the 4,438 students in grades 7 marijuana use implementation of schoolbased and 9 prevention curricula

Project Northland
Combines coalitionled community 24 school districts in Minnesota; Reduced binge drinking and (Perry et al. 2002) mobilization strategies with the 2,953 students in grade 6 alcohol sales to minors implementation of schoolbased prevention curricula

Native American Project
Combines coalitionled community 27 tribal and public schools Reduced smokeless tobacco, (Schinke et al. 2000) mobilization strategies with the in the Midwest; alcohol, and marijuana use implementation of schoolbased 1,396 students in grades 3-5 prevention curricula DARE Plus (Perry, Komro, Combines coalitionled community 24 schools in Minnesota; 7,261 Reduced pastyear and past VeblenMortenson et al. 2003) mobilization strategies with the students in grade 7 month smoking and drinking for implementation of schoolbased boys and having ever been drunk prevention curricula for girls  Holder et al. 2000) changes to community policies, South Carolina adults, alcohol sales to minors, practices, and norms related to and alcoholrelated car crashes alcohol use coalitions focused on preventing alcohol use by youth may include representatives from law enforcement, local gov ernment, schools, health and human service agencies, youth service groups, business, religious groups, youth, and parents. The coalitions typically are formed around a common vision that inspires and motivates their actions. By working together to bring about change, they allow intervention approaches to be tailored to local needs, as identified by coalition members. They also increase political alliances, foster communication among community members, and coordinate human and financial resources (Hawkins et al. 2002;Pentz 2000;Wandersman et al. 2003).
Although coalitions are a common element of effective communitybased prevention, not all coalition efforts have produced significant changes in alcohol use. Some coalition initiatives have failed to reduce rates of AOD use among youth and adolescents, even when they were well funded and members were well intentioned and willing to make changes. Evaluations of two coalition efforts-the Fighting Back (Hallfors and Godette 2002) and Community Partnership (Yin et al. 1997) initiatives-found that both failed to bring about changes in youth AOD use. The evaluations indicated that the coalitions involved in these projects had insufficient guidance in how to enact preven tion strategies, varied widely in the nature and amount of prevention services provided, and largely relied on locally created prevention strategies that likely had not been pre viously evaluated for effectiveness in reducing AOD use. These studies suggest that the mere presence of an active, wellintentioned coalition is not enough to prevent AOD use. In other words, simply gathering local stakeholders and asking them to collaborate to do their best to solve local drug problems or prevent underage drinking does not produce desired changes.
Instead, the evidence suggests that in order to be successful, coalitions must ensure the following ): • They must have clearly defined, focused, and manageable goals; • They must have adequate planning time; • Prevention decisions must be based on empirical data about what needs to change in the community and on evidence from scientifically valid studies of what has worked to address those needs; • They must implement prevention policies, practices, and programs that have been tested and shown to be effective; and • They must carefully monitor prevention activities to ensure implementation quality.
One prevention system that exemplifies these principles is Communities That Care (CTC), which has been found to reduce the initiation and prevalence of youth alcohol use communitywide (Feinberg et al. 2007;Hawkins et al. 2009). CTC provides proactive training and technical assistance to community coalitions to ensure that they select and implement prevention strategies that previously have been demonstrated to be effective in reducing youth AOD use. The CTC model involves a structured and guided intervention process involving five phases in which coalitions (1) assess community readiness to undertake collaborative prevention efforts, (2) form a diverse and representative prevention coalition, (3) use epidemiologic data to assess prevention needs, (4) select evidencebased prevention policies and programs that target these needs, and (5) implement the new policies and programs with monitoring to ensure fidelity and evaluation to ensure that goals are being met. The coalitions are structured, ideally with a chair person, cochairs, and workgroups; employ at least a halftime coordinator; and are broad based. The prevention activities chosen and implemented can take place in a variety of settings and may target indi vidual, family, school, peer, and/or community risk and protective/promotive factors related to youth AOD use. They are selected by the community coalitions from a menu of options that only includes policies and programs that have been shown in at least one study using a high quality research design to significantly change risk and protective factors and reduce rates of AOD use Hawkins et al. 2002).
Several evaluations of the CTC coalition model have been conducted, including a randomized trial involving 24 communities in 7 States that were randomly assigned to either implement the CTC system (n = 12) or serve as control communities (n = 12) (Hawkins et al. 2008). The intervention sites received training in the CTC model, proactive and intensive technical assistance, and funding for 5 years to plan and implement their chosen prevention strategies. This study found that after 4 years of the inter vention, students in the CTC communities had lower rates of AOD use compared with students in control commu nities. They were less likely to initiate cigarette, alcohol, and smokeless tobacco use as well as delinquent behavior by the eighth grade. In addition, eighthgrade students in the intervention communities reported significantly lower rates of drinking, binge drinking, and smokeless tobacco use in the past month, as well as delinquent behavior in the past year, compared with students in the control com munities ).
These results indicate that when local community coali tions are provided with proactive training and technical assistance, have clear goals and guidelines, and ensure effective implementation of prevention strategies that have prior evidence of effectiveness, they have the potential to significantly reduce alcohol and tobacco use as well as delinquent behavior communitywide. Moreover, the findings indicate that coalitions may enact a variety of prevention policies and programs targeting a range of different risk and protective factors and still be successful, as long as their efforts focus on using methods that have been demonstrated to be effective and ensure that prevention activ ities are carefully implemented, monitored, and coordinated.

Inclusion of SchoolBased Curricula in Community Based Efforts
Implementation of universal, schoolbased drug prevention curricula as part of the larger community effort appears to predict reduced rates of AOD use among middle and highschool students. All of the initiatives listed in the table that were effective in preventing or reducing alcohol use among those younger than age 18 involved the imple mentation of a schoolbased curriculum. Although neither the CTC prevention system nor the Kentucky Incentives for Prevention initiative (Collins et al. 2007) requires the use of schoolbased curricula, all of the coalitions involved in the randomized CTC evaluation ), and all but one of the 19 coalitions evaluated in Kentucky, implemented a school curriculum to target particular risk factors whose influence in the community was considered too high or protective factors whose influence was consid ered too low by local coalitions.
The other communitybased prevention initiatives listed in the table that reduced alcohol use among those younger than age 18 involved implementation of a particular school curriculum offered to students in conjunction with coalition led efforts to change communitylevel risk factors related to drug use. The latter efforts typically attempted to change community norms and local ordinances related to alcohol use and availability. An evaluation of the Project Northland Program in Minnesota (Perry et al. 2002), for example, demonstrated reduced rates of alcohol use in communities that implemented a multiyear school curriculum and modified local policies and practices associated with youth alcohol use. The school program focused on altering student views regarding the acceptability of alcohol use, improving student skills in refusing drug offers, and fos tering parent/ child communication about alcohol use through homework assignments and information mailed to parents. Environmentally focused strategies included increased identification checks by retail liquor establish ments and legal consequences for selling alcohol to minors. The evaluation of Project Northland found that after receiving services in both middle and high school, students in the intervention communities had lower rates of binge drinking (i.e., drinking five or more alcoholic beverages on one occasion) compared with students in control communities. In addition, retail establishments were less likely to sell alcohol to minors in intervention than in control communities (Perry et al. 2002).
A similar combination of activities was advocated in the Midwestern Prevention Project (MPP). This program involved the implementation of a 2year middleschool curriculum to promote students' drug resistance skills, along with parent education, media campaigns to rein force antidrug messages throughout the community, and local policy changes to reduce demand and supply of drugs. When implemented in schools in Kansas City, the MPP demonstrated reductions in pastmonth smoking and alcohol use for students receiving the intervention com pared with students in control schools (Pentz et al. 1989).
In Project SixTeen, small communities in Oregon implemented a fivesession, schoolbased program aimed at reducing youth tobacco use, along with media cam paigns and responsible beverage training for alcohol retail outlets. The evaluation showed a significant reduction in pastweek smoking and marijuana use for seventh and ninthgrade students in intervention communities com pared with control communities; similarly, alcohol use was reduced among ninth graders (Biglan et al. 2000).
These studies indicate that the inclusion of schoolbased prevention programs in comprehensive, coalitionled, communitybased initiatives can contribute to reductions in alcohol use among adolescents. Currently, most schools in the United States provide some type of drugprevention programming to students. However, not all school districts implement strategies that have evidence of effectiveness, even though the Safe and DrugFree School (SDFS) legis lation mandates the use of effective substanceuse preven tion curricula. Inclusion of schoolbased programs in larger community prevention initiatives provides multiple advantages, including the ability to reach a large proportion of the youth population and thus increase the potential of achieving communitylevel changes in desired outcomes. Community coalitions can help school districts fulfill the SDFS mandate by helping them identify and adopt effective strategies and by helping to ensure that the new programs are well suited to addressing the needs of local students. In addition, coalitions can partner with schools to find the needed resources to initiate and sustain new effective prevention strategies and can help oversee the implemen tation of new strategies to ensure quality. To promote successful partnerships, coalitions should ensure that school personnel, including administrators (e.g., superintendents and principals) and staff (e.g., teachers and counselors), are actively involved in the decisionmaking process and prevention efforts from the beginning of the initiative (Fagan et al. 2009).

Targeting Environmental Risk Factors for Substance Use
The initiatives just described combined the implementation of school curricula with community mobilization efforts that target environmental risk factors in order to reduce the availability of and demand for alcohol. Such efforts include changes in communitylevel policies, practices, and norms, such as increasing alcohol pricing, creating drugfree zones, limiting alcohol sales in venues easily accessible to youth, requiring keg registrations, and increasing the use or severity of community laws related to alcohol use by minors or adults (Pentz 2000;Wagenaar et al. 1994). Changes in community practices also may involve responsible beverage service training-that is, educating merchants about the negative consequences of providing alcohol to minors or serving intoxicated patrons, encouraging identification checks, and ensuring that mer chants who violate rules are appropriately sanctioned (Holder 2000). Media campaigns may also be used in con junction with these activities to educate the public about the negative effects of alcohol use, increase support for drug pre vention, and counter norms favorable to alcohol use. Such media campaigns increase public awareness by saturating the community with print, radio, and television advertisements; mailing informational fliers to businesses or homes; or hold ing community forums to discuss alcoholuse issues.
Evidence is mixed regarding the effectiveness of these types of environmentally focused prevention strategies. As discussed in the previous section, when offered in con junction with schoolbased prevention curricula, these prevention strategies seem to be effective in reducing rates of adolescent alcohol use. However, efforts that focus exclusively on changing environmental risk factors at the local level, without also targeting more proximal risk factors related to alcohol use, have not been associated with reductions in alcohol use among youth under age 18. An evaluation of Communities Mobilizing for Change on Alcohol (CMCA) found no statistically significant changes (i.e., p<.05 using twotailed test of significance) in alcohol or drug use among 12thgrade students or 18 to 20year olds in communities implementing CMCA compared with those in control communities (Wagenaar et al. 2000b). In this project, community coalitions coordinated a vari ety of activities aimed at limiting alcohol sales to minors, increasing enforcement of underage drinking laws, and changing alcohol policies at community events, as well as increasing public attention about problems associated with underage drinking. Although rates of alcohol use by youth were not significantly changed by the intervention, the evaluation did show that 18 to 20yearolds from intervention sites were significantly less likely to provide alcohol to minors (Wagenaar et al. 2000a,b).
The Community Trials Project used similar environ mentally focused prevention strategies to reduce alcohol use and related risky behaviors. A quasiexperimental evaluation of this program in six communities indicated significantly fewer alcoholrelated automobile crashes in intervention communities than in control communities . Among adults (those age 18 or older), a greater proportion of those in communities implementing the program reported having one or more drinks in the past year versus those in comparison communities. However, among those who reported any drinking, adults in inter vention sites had lower rates of selfreported heavy drinking and drunk driving . Although there were fewer sales to minors by alcohol sales establishments in intervention versus comparison sites (Grube 1997), none of the evaluations of the Community Trials Project have found significant reductions in drinking among youth under age 18 in intervention versus comparison sites.
The available evidence indicates that these types of communitybased, environmentally focused strategies are effective in reducing alcohol use among those under age 18 only when offered in conjunction with effective school curricula. However, few evaluations have been conducted of communitybased prevention efforts that rely solely on changing community policies, practices, and norms, and more research is needed to assess the impact of environ mental strategies when used independently and when combined with other types of prevention strategies.

Challenges Associated With Community Mobilization Efforts
There is much public support for community mobilization efforts that seek to reduce substance use, particularly by youth and young adults, and many communities have coalitions in place to coordinate local prevention strategies. However, implementing, evaluating, and sustaining such efforts can be challenging. For example, it often is difficult to recruit, engage, and ensure collaboration among community members from diverse backgrounds who may have different skills, needs, resources, and ideas about what is needed to prevent AOD use (Merzel and D'Afflitti 2003;Quinby et al. 2008;Stith et al. 2006). Furthermore, compared with single prevention programs, community level strategies likely are costlier to implement and evaluate because they entail more components and require longer term interventions to achieve communitywide outcomes (Merzel et al. 2003). It also can be difficult to define community boundaries, gain support for participation in a research study from key leaders and stakeholders, and measure processes and outcomes that may vary across communities (Stith et al. 2006;Wandersman et al. 2003). Finally, communitybased prevention strategies are intended to be owned and operated by the community, which can create tension between local practitioners and scientists who may differ in their ideas about what is most needed to prevent alcohol misuse (Holder et al. 1997;Hyndman et al. 1992;Merzel et al. 2003).
The many challenges related to the implementation of communitybased prevention efforts likely are responsible for the relatively small number of interventions that have demonstrated evidence of success (see the table). In addition, evaluations of some community prevention programs have failed to demonstrate significant effects on alcohol use, sometimes because of problems related to program imple mentation and intensity. For example, the initial evalua tion of Project Northland in Minnesota indicated that the original 3year intervention, which was implemented in middle schools, was insufficient to lead to sustained effects on alcohol use. Therefore, additional services were added in high schools, which reduced rates of alcohol use through grade 12 (Perry et al. 2002). A replication of this extended program in Chicago, Illinois, however, failed to produce positive effects, which led the evaluators to rec ommend that in lowerincome, urban populations, where problems other than youth alcohol use (e.g., gangs, violence, and housing) may take precedence, longerterm and more intense communitybased strategies may be needed to bring about change (Komro et al. 2008).
The Project Northland replication in Chicago and other evaluations have noted that implementation challenges, such as difficulties in engaging community members in the initiative and challenges in moving from planning to action, may compromise the ability of communitybased efforts to produce significant effects. On the other hand, evaluations of the CTC prevention system have shown that communities can successfully mobilize volunteers, create highfunctioning and goaldriven coalitions, and ensure highquality implementation of prevention strate gies that target salient risk and protective factors (Quinby et al. 2008). One factor that increases the likelihood of success is the provision of proactive and highquality training and technical assistance from system developers to the community coalitions ). In the absence of such training and technical assistance, com mon implementation challenges are likely to threaten implementation and the likelihood of realizing desired reductions in youth alcohol use.
Research also has indicated that communities that rely on preventionfocused coalitions, as in the CTC model, can successfully sustain the implementation of tested and effective programs, despite the human and financial costs associated with these efforts. An evaluation of 110 CTC coalitions in Pennsylvania  indicated that nearly all coalitions (91 percent), which still were operating after the State discontinued funding for CTC activities, continued to implement effective programs. In fact, on average, the coalitions were able to fund their program and coalition activities at levels exceeding those initially provided by the State. Funding success was posi tively associated with having a wellfunctioning coalition, adhering to the CTC model, and planning for sustainabil ity. These findings reinforce the importance of utilizing broadbased coalitions to plan, implement, and sustain prevention activities in communities.
Identifying the costeffectiveness of communitybased prevention initiatives also is important. Although the review presented here identified nine communitybased strategies with evidence of effectiveness in reducing alcohol use and availability among minors, only two of these interventions have been rigorously evaluated for cost effectiveness. In both cases, the analyses demonstrated fiscal savings. According to the Washington State Institute for Public Policy (Aos et al. 2004), every dollar spent on Project Northland in Minnesota resulted in savings of $2.45 in later treatment, morbidity, mortality, and criminal justice costs; similarly, the MPP produced savings of $1.27 per dollar spent. Because cost is a major factor influencing community decisions to adopt new programs, information on financial benefits may help to increase the dissemina tion of communitybased prevention strategies, their long term sustainability, and ultimately their potential to sub stantially reduce rates of alcohol use among young people.
In summary, this review clearly has shown that community based efforts can reduce alcohol use and misuse among youth. A common feature of successful community strategies is reliance on local coalitions to select and fully imple ment preventive interventions that have prior evidence of effectiveness in changing risk and protective or promotive factors related to alcohol use. Inclusion of a universal, schoolbased prevention curriculum in the larger community based effort is associated with lower rates of drinking, binge drinking, and other drug use by those younger than 18. Focusing communitybased prevention efforts on youth offers particularly great potential, because it not only lowers rates of alcohol use among minors but also reduces the likelihood of alcohol misuse and dependence later in life (Hingson et al. 2006).